Long term results of intraoperative mitomycin C in the treatment of recurrent pterygium

Institute of Ophthalmology, University G D'Annunzio, Chieti, Italy.
British Journal of Ophthalmology (Impact Factor: 2.98). 05/1996; 80(4):288-91. DOI: 10.1136/bjo.80.4.288
Source: PubMed


The study was designed to evaluate the long term results of intraoperative mitomycin C in patients with one recurrence of pterygium.
In 45 white patients with one recurrence of pterygium the 'bare sclera technique' was performed and a sterile sponge soaked in a 0.2 mg/ml (0.02%) mitomycin C solution was placed intraoperatively on the sclera for 3 minutes. The control group underwent surgical excision only. Recurrences were analysed by the chi 2 test and the method of Kaplan-Meier (life table analysis); the difference between survival curves was tested by the log rank test. The chi 2 test with Yates's correction or Fisher's exact test were used to analyse the difference in complications and side effects between the two groups.
After a mean postoperative follow up of 34.55 (SD 13.70) months, 6 recurrences (12.5%) were observed in the mitomycin C treated patients and 16 (35.6%) in the control patients (p = 0.027). The 24 and 48 month life table success rates were 89% and 83% in the mitomycin C treated group and 66% and 63% in the control group, respectively (p = 0.022). No severe side effects appeared during follow up. Superficial punctate keratitis appeared in the early postoperative period in only seven mitomycin C treated eyes (15.5%) (p = 0.018).
This study confirms the efficacy of intraoperative mitomycin C in improving the success rate after recurrent pterygium surgical excision.

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Available from: Pier Enrico Gallenga
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    • "MMC is an effective intraoperative treatment for preventing recurrence of pterygium.[10–12] The effect of the drug depends on the dose and the length of application.[13] "
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    ABSTRACT: To determine the efficacy of preoperative subconjunctival injection of mitomycin C a day before surgery in the management of recurrent pterygium. Randomized comparative case series. Fifty eyes with recurrent pterygium were randomly divided into two groups; the mitomycin injection group (25 eyes) and the mitomycin application group (25 eyes). The mitomycin injection group underwent preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before bare sclera pterygium excision surgery. The mitomycin application group underwent bare sclera pterygium excision with topical application of mitomycin C (same concentration). At one year of follow-up, 24 of 25 eyes (96%) in the mitomycin injection group and 23 of 25 (92%) eyes in the mitomycin application group were free of recurrence. The difference was statistically insignificant. As regards postoperative complications, delayed epithelization (more than two weeks) occurred in two eyes (8%) in the mitomycin injection group and in one eye (4%) in the mitomycin application group. Scleral thinning was reported in one eye (4%) in the mitomycin application group which resolved within three weeks after surgery, no other serious postoperative complications were reported. Preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before pterygium surgery is a simple and effective modality for management of recurrent pterygium. It has the advantage of low recurrence and complications' rate.
    Full-text · Article · Jul 2012 · Indian Journal of Ophthalmology
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    • "The anti-fibrotic effect of anti-metabolites as mitomycin C (MMC) and 5-fluorouracil made them useful tools to be used during surgical excision of pterygium. Concentration of these drugs should be properly adjusted to avoid and prevent serious complications as scleral melting, ulceration or delayed epithelization (Mastropasqua et al., 1996). Amniotic membrane being a basement membrane acts as a new healthy substrate suitable for proper epithelization, it has a strong antiadhesive effect (Xi et al., 2003) being normally avascular thus inhibit the incursion of new vessels (Dua and Azuara Blauco, 1999). "
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    ABSTRACT: To assess and compare the recurrence rate of pterygium after limbal stem cell transplantation versus amniotic membrane transplantation (AMT) as ocular surface reconstructing measures in recurrent pterygium, also evaluation of the use of antimetabolite drugs as adjunctive therapy for AMT. Prospective randomized comparative study included 60 eyes of 48 patients with recurrent pterygia. Informed consents were taken from all patients. Primary pterygium excision was performed 6-15 months ago; the cases were divided randomly into three equal groups: Group 1: included 20 eyes with excision of the pterygium and application of limbal stem cell transplantation with conjunctival autograft, group 2: included 20 eyes with excision of the pterygium followed by AMT and group 3: included 20 eyes in which surgical excision of pterygium was followed by intra-operative application of low-dose of MMC (0.05%) for 3 min then using AMT. The study included 36 males and 12 females of age ranged from 28 to 52 years. The recurrence rate was 2 eyes in group 1 (10%) (limbal stem cell transplantation + conjunctival autograft), 6 eyes in group 2 (30%) (AMT) and 4 eyes (20%) in group 3 (MMC + AMT). The rate of recurrence was significantly different between the three groups (P < 0.001). Limbal stem cell transplantation together with conjunctival autografting proved to be more effective in prevention of pterygium recurrence and in rapid restoration of normal epithelial morphology. MMC in addition to AMT decreases the incidence of recurrence.
    Full-text · Article · Oct 2011 · Saudi Journal of Ophthalmology
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    • "In a randomized clinical trial, Lewallen7 reported a 40% recurrence rate with the bare sclera technique versus 7% with conjunctival autografts. Intraoperative application of mitomycin C to the scleral bed is another strategy which has gained increasing acceptance but entails several complications.8,9 "
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    ABSTRACT: Purpose To evaluate the outcomes of primary pterygium excision with adjunctive amniotic membrane transplantation. Methods In an interventional case series, consecutive patients with primary pterygia underwent surgical excision with transplantation of preserved amniotic membrane onto bare sclera. Patients were followed for at least 12 months and the results were evaluated in terms of recurrent pterygium growth and complications. Results Fifty eyes of 50 consecutive patients including 27 male and 23 female subjects with mean age of 43.36±10.88 years were operated. The pterygia extended onto the corneas for 4.69±1.2 (range 3 to 7) mm. Only one eye (2%) demonstrated recurrent pterygium growth which responded to subconjunctival mitomycin C injection. Another eye (2%) developed amniotic membrane retraction which eventually required a second transplantation leading to complete resolution. Conclusion Primary pterygium excision with amniotic membrane transplantation is a safe and effective surgical technique with low recurrence rate.
    Full-text · Article · Jan 2008
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